Óxido nitroso. Uso como droga recreativa de una sustancia de uso profesional

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El objeto de la presente entrada en el blog es reflexionar respecto a los “globos” o “balones” que de manera mayoritaria han difundido informativamente prácticamente todos los medios de prensa a raíz de la operación llevada a cabo por el Cuerpo Nacional de Policía en varios locales de ocio en Marbella (Málaga); determinando sus efectos, consecuencias físicas y psicológicas, presentación en el mercado y efectos cuando se consume conjuntamente con alcohol.

Generalmente los globos ofrecidos en locales de ocio, están rellenos de óxido nitroso empleado de forma recreativa y con fines lúdicos. El óxido nitroso es un gas anestésico usado en la anestesia general, en asociación con los demás agentes de anestesia administrados vía intravenosa o por inhalación. También es usado como coadyuvante de la analgesia en el quirófano o en la sala de trabajo médico (cirugía menor, odontología, curas locales complicadas). En este último caso, la presentación comercial del preparado va al 50% de óxido nitroso con oxígeno en “biberones” que el paciente inhala antes de la intervención, inhibiendo en gran medida la percepción nociceptiva. Fuera del uso médico, su utilización mas extendida es la gastronómica mediante el uso a través de sifones con los que se preparan espumas y cremas de aplicación culinaria, así como en coctelería.  Recreatívamente se vienen usando para inducir un estado alterado de gran intensidad durante breves instantes, que no suelen superar el minuto. A nivel de usuarios de ocio, se le denomina vulgarmente “gas de la risa”, lo que aproxima bastante al objetivo de utilización de este compuesto.

Su presentación en globos, se debe a que el gas recién extraído de las cápsulas que lo contienen (de uso y venta legal en tiendas de productos y herramientas de alta cocina para uso con sifones de cocina), se encuentra a varios grados bajo cero y la aplicación directa de los labios sobre el instrumento que se use para su extracción, produciría quemaduras por frío. Igualmente, se utilizan los globos debido a que de una sola cápsula, se pueden extraer varias dosis de fácil preparación y contención en los mencionados globos, que a su vez facilita la administración al usuario, siendo ésta por vía inhalatoria.

Tras los iniciales efectos euforizantes, que vienen a durar unos segundos, se produce una fase de depresión del sistema nervioso central como gas anestésico que es, potenciado a su vez por la disminución / anulación de la inhalación de oxígeno mientras se está respirando el gas. Debemos tener en cuenta que en la presentación médica de este producto, va mezclado con distintas proporciones de oxígeno, pero en la presentación culinaria (la usada para la elaboración de los globos), el producto va puro, de modo que el tiempo de inhalación del compuesto es un tiempo que funcionalmente se puede equiparar a la apnea por falta de aporte de oxígeno.

Los efectos físicos son los derivados de su capacidad anestésica / analgésica; así como los derivados de sus efectos secundarios como puedan ser la potenciación de tóxicos depresores del sistema nervioso central (llegándose a situaciones de desmayos por falta de oxígeno sanguíneo), nauseas, vómitos, anemia megaloblástica o granulocitopenia. . A nivel psíquico, encontraríamos unos segundos iniciales de euforia seguidos de una situación comportamental de depresión del sistema nervioso y psicodislexia (dificultad para la lectura). Su uso conjunto con alcohol, por tanto, básicamente viene marcado por la potenciación de los efectos del mismo; es decir, se potenciaran los efector elevadores del estado de ánimo (euforizantes) en las primeras fases de consumo alcohólico (de muy breve duración en el caso de los globos de óxido nitroso),  y se producirá una fase depresora de la intoxicación etílica mas marcada y duradera.

Link a nota de prensa del Ministerio del Interior de fecha 8 de septiembre de 2013 respecto a la operación policial realizada en Marbella por la II Unidad de Delitos Especiales y Violentos,  adscrita a la Brigada Local de Policía Judicial de Málaga.

http://www.interior.gob.es/press/la-policia-nacional-detiene-a-tres-personas-en-marbella-por-distribuir-globos-con-gas-de-la-risa-15667

Eduardo Ramos About Eduardo Ramos
Eduardo Ramos Campoy. Mente amplia e inquieta, de curiosidad insaciable. Ejerciendo en la actualidad como Médico Forense en el Instituto de Medicina Legal de Málaga. Máster en Ciencias Forenses y Derecho Sanitario. Especialista Universitario en Psiquiatría Forense.

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32 comentarios de “Óxido nitroso. Uso como droga recreativa de una sustancia de uso profesional

  1. Pingback: Óxido nitroso. Uso como droga recreativa...

  2. NO2 is a powerful but very short acting dissociative. Its subjective effects are very similar to IV Ketamine, but only last a minute or two after inhalation.
    When first discovered, NO2 was called “laughing gas” was originally used as an entertainment. From ~1799 onwards it was used recreationally at wealthy parties, and as an entertainment for the poorer masses in the early 19thC showmen would charge admission to a tent and then gas members of the audience for their own and other’s amusement;
    http://www.lsdimension.com/wp-content/uploads/2011/08/laughinggas-advert.jpg
    .
    It wasn’t actually used as an anaesthetic until 1844.
    http://connecticuthistory.org/horace-wells-discovers-pain-free-dentistry/
    .
    It is useful in dentistry, safer than general anaesthetics, although (like ketamine) the dissociative effects are unpleasant and disturbing for some patients. It is very useful in childbirth, inhaled during rests between “pushes”, as it profoundly dissociates but wears off very quickly.

    It is relatively harmless, with a few provisos-
    Judging by studies with dentists or midwives who misused NO2, chronic use for many years may be associated with a slightly higher than normal rate of osteoporosis later in life.
    Although there were suggestions in the 1990s that NO2 might increase heart attack risk, these fears appear to be unfounded.
    http://news.wustl.edu/news/Pages/25544.aspx
    .
    But the stuff CAN kill you. By far the biggest danger is asphyxia. NO2 binds to haemoglobin more strongly than oxygen does. Nitrous oxide released in a confined space will displace oxygen from the room as well.

    When NO2 is used in dentistry or midwifery, it is regulated through a mask that also ensures sufficient oxygen is inhaled. When it is used recreationally it is almost never used with this piece of equipment.

    Most cases of fatal asphyxiation result from someone wearing a mask to inhale the gas from a cylinder without any O2, and then falling unconscious and continuing to inhale, or from the person opening a cylinder inside a car, or inside a sealed room (for example blocking cracks around the doorway with rolled towels etc).
    http://upload.wikimedia.org/wikipedia/commons/c/ce/N2O_Medical_Tanks.jpg
    .
    http://www.ncbi.nlm.nih.gov/pubmed/1506823
    .
    Many young people inhale NO2 for “cream charger” bulbs (used for whipping cream, and known colloquially as “Nangs” by people who inhale the gas here in Australia). Similar bulbs labelled “Soda Chargers” are filled with CO2, not NO2, so don’t inhale from those!
    http://www.cateringandleisure.com/productPanel/images/uploads/bw-16g-5pk.jpg
    .
    The bulb is released into a cream charger without adding any cream, and then the gas can be controllably released into the mouth through the nozzle;
    http://i.ebayimg.com/t/Mosa-1-pint-Professional-Whip-Cream-Maker-Whipped-Cream-Dispenser-New-/00/s/MTI4MlgxNDAw/$(KGrHqFHJBkE+NnFop-6BPzt)h!Lrg~~60_35.JPG
    .
    Injury sometimes result to the lips, mouth, throat or lungs when people release the gas directly from a cylinder, or (if they resort to using a nail or pin to puncture the lid) directly from a “nang” bulb, into the mouth, as the gas is initially quite cold due to the pressure drop. Very occasionally this injury is severe enough to occlude the throat and again asphyxia may result. Unlike the medical gas from a cylinder, the cream charger bulbs are not designed to be inhaled. Very occasionally tiny pieces of the metal foil that seals the lid may be aspirated or forcibly driven into the lungs of the person who inhales.
    http://www.sciencedirect.com/science/article/pii/0305417995000909
    .
    The means of administration you describe is probably the safest improvised way to inhale this gas. Whether the nitrous oxide comes from a cylinder or a bulb, it is used to inflate a party balloon. The gas is then “sipped” from the balloon, and when the desired effect is reached, the inhaler simply pinches the balloon closed. Should the person loose consciousness they will release the balloon;
    http://i.dailymail.co.uk/i/pix/2013/07/25/article-0-1AFDB46F000005DC-536_634x400.jpg
    .
    I would like to stress again that although asphyxia, cold burn or inhalation injury is possible, NO2 is (relatively speaking) very safe.

    Some anecdotal observations re: risk of adverse responses and accidental poisoning by nitrous oxide.

    When I was younger, over a period 6 years I witnessed several hundred (~700-800?) non-medical self-administrations of nitrous oxide, in a population of perhaps 90 or 100 individuals, almost all of whom were also using cannabis chronically, and most of who were regular users of amphetamines, MDMA, LSD or other hallucinogens, and/or opioids.
    Subsequently, I have spent the last 13 years working in a role where I am in daily contact with many people who use a variety of drugs illicitly and who openly discuss their experiences.

    Amongst this admittedly uncontrolled and rather unscientific sample, I have seen a dozen people suffer “frost nip” (minor, first degree cold-burns) to lips, mouth, or the back of the throat from inhaling very cold bursts of the gas. I have never been told of a fatality within this population attributable to recreational inhalation of NO2, and have never seen serious injury or a serious adverse reaction to NO2.

    I am aware of one individual who fell unconscious on the floor of a dental surgery, and was not woken until the next morning by the receptionist unlocking the office. (Rather embarrassing, as he lived upstairs and the dentist was his landlord). However this fellow was also using benzodiazepines and high doses of morphine on a daily basis.

    On two occasions out of these many hundreds I have seen people have a brief seizure after inhaling nitrous oxide. One was a person with a previous history of seizure, who had never tried the gas before. She recovered within about 3 minutes, suffered no injury, but wisely decided to not inhale NO2 again.
    The other case was a young man who had never suffered a seizure. He had consumed no other drugs apart from a modest amount of alcohol, and began fitting immediately after a single inhalation of NO2. It was the first time he had tried it.
    He was seated cross-legged on the floor, and as he started fitting he head-butted a glass coffee-table 3 times, hard enough to break cartilage in his nose. When he came to a minute later, and found me leaning over him as I placed him in the recovery position, he angrily asked what I was doing. It took several other people in the room, and a mirror, to convince him that he had injured himself. Like the woman I mentioned above, this fellow hasn’t inhaled NO2 since. I still see him occasionally and he has never suffered another seizure.

    So, be aware that although there isn’t that much in the literature about it, NO2 does appear to lower seizure threshold, (temporarily, for the duration of intoxication) in some people.
    Here’s three cases of seizure after NO2 administration in children;

    <<>>

    http://jcn.sagepub.com/content/25/12/1517.abstract
    .
    Paul Dessauer,
    Outreach Coordinator,
    WASUA.

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